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<br />' _ � • . , . • :lOZLDINC PERHIT APPLICATION . '. . • '' .•, /�-7��J�/
<br /> ' • 3pplicant To Complete This =orm • � '•. 1 �� !
<br /> . � • , /
<br />' � ft eore than one buildinq ia to be contructed, submit a separate pezmit appl3ca�y5�
<br /> � .• : tiaa for each buildinq. 11 separate permit will be issued for each buildinq.
<br /> .�� � .
<br /> .� Ovner ��;�/0��...�i�p,L�,rr�/ Dnilding Address � '
<br /> '' ' iddresa c� /�,
<br />' . � U' ��� �/�.,.,,.8 �G�-L- 7.ot h ') Block �/�%.r9- D D
<br /> —�.-,.,
<br /> •'�„• . �� City Yn�i�Pwo� Phone„?/�-�795� 3ubdivision (Plat) ' �
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<br /> � 1reLitect/Engineer �y��� ,�,�r �' .
<br /> • '+:. ''� City • Phone Metes i Bounds (Unplatted) —
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<br /> .;�� Camtractor ���A.� P.�l�1�I � • Sec. 1Vp. ' Rqe -- �
<br /> _ ;' i . .
<br /> : ;• . �• 3dEress . . • . .
<br /> .,i Citp Phone .Hnilding IIse . . , ,;.Y,;..�
<br /> .�'4'✓�
<br /> ;• ' �'y� � Stite,License 21�aber _ : ' Describe Work to Be Done ,
<br /> ,.�' . . .
<br />' • '�i Ltpiration Dat� • ��,r,v yLy.t-rr�' „p,Te',.o,si ;.
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<br /> ��: ,; . : • _
<br /> � % S1�TCli PIAT PLAN B£LOW' �
<br /> .•-.. �,� , , . ..:. ' • . . . . .
<br /> ���� ��J� II�e of Building '
<br /> �� � . . , � ;.5"� -� u-.�z.�"
<br />_ j � ,�„_��-- , •I�Nea ❑ Addition f$I Repair/Remofiel
<br /> . . �.t' • . i;.� ' :5 : `' o '
<br /> , j ' • • �.- • •Valnation of Construction $ /�D� "
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<br /> +- .. �. . . � . ^ . PLOT PLA2i REQUIBE.�ffiNTS _ .
<br /> � �' : ' ' _ r� � ' ' . . ' �.s
<br /> .'1 • . _ ' • ' Iadicate lot size, nane of streets, �
<br /> �' ' .'^.' � '� � '� •3ndicate location anc width of
<br /> ' • .' •;� . : . '' y,;- •' :-:= t.4�''�� alleys, locate pr000sed and all �
<br /> ' `'� ' ' � " existing buildings, show distances
<br /> . �, :-,. . _ .;
<br /> _ F� ' ^!• ' . . � ' ' . . to property lines, show distznces
<br /> , i . � : • between buildings. .
<br /> i _ • � i.ot size _ x
<br /> •' _ ,•.
<br /> •" `. Lot area Sq. Ft.
<br /> � r.: � ' Size of IIldg. Sq. Ft.
<br /> ' : �� =• liumber of Stories •
<br /> y • �� ' ' • :� ;,yj �? Basement
<br /> �+i:.� . . . Signed By���i�„�,. �.��aML�
<br /> _ . ; . � . . �� 8or ,
<br /> . : . '. '. ' ' ' . . - � Owner Phone �.q?. pz j s .
<br /> -, ' ' DO NOT ':3ITG BELO[�7 THIS LI:IE-FOR CITY iJSE Ot7L'1 '
<br /> — .- Date `:eceived J �-O �S1 ' U�e Zone •
<br /> ' Ylan•Chec� :Iurber ' � Fire 2one '
<br /> Valnatioa � / �J�• ��" Occuoancy Grou� � '
<br />� : � Pemit Fee S- Yype of Construction � .
<br /> ' Plan Check Fee Occupant Load
<br /> . , � Rbtal Fee Due � ' �� Sprinklers Required '
<br /> I . . . Datc Issued ' � 'S0 Z ` . • .• , . . �~
<br /> � ,. , 1 ... . , ". . , '. �, . , • � . n�, ^ '''� • j � ,.r.
<br /> I •� . . . • .. ' . . . . ' • �•, � 3Jf•�� � ,
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